Provider Demographics
NPI:1134255250
Name:TENORIO, RUBEN LONGORIA JR (DO)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:LONGORIA
Last Name:TENORIO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 CASTROVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5147
Mailing Address - Country:US
Mailing Address - Phone:210-432-8871
Mailing Address - Fax:210-271-9655
Practice Address - Street 1:432 CASTROVILLE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5147
Practice Address - Country:US
Practice Address - Phone:210-432-8871
Practice Address - Fax:210-271-9655
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1309684-02Medicaid
TXQY98Medicare ID - Type Unspecified
TX1309684-02Medicaid